This blog documents the journey of Marla Crider, a 60 year-old travel professional from Little Rock, Arkansas, as she battles a breast cancer called invasive ductal carcinoma (stage 3). From the moment of her diagnosis, she chronicles her experience. Be forewarned this blog may provide a raw glimpse into the author’s psyche and ability to deal with a life threatening challenge. Hopefully, her honesty and humor will provide advice and help to others who find themselves in a crusade of their own.

Sunday, October 20, 2013

It was exactly one week before my scheduled bilateral
mastectomy. I had been waiting for
nearly an hour with more than a dozen other patients at the Winthrop P.
Rockefeller Cancer Institute to see Dr. Makhoul, my oncologist, for the results
of the recent breast MRI. The good doctor had recently been appointed the new
director of oncology at the University
of Arkansas for Medical
Sciences and was busier than ever. Since being diagnosed with cancer six months
earlier, I had learned the virtue of patience and it was a good thing.

Don had a conflict and couldn't accompany me to my
appointment with Dr. Makhoul, but I was okay with going solo because I felt
good about the pending results.After
being called to the exam room, I waited anxiously for Dr. Makhoul to
enter.A few minutes passed and the door
opened, but it wasn’t Dr. Mak.Instead,
a new doctor entered the room.He introduced
himself as an oncology “fellow,” training with Dr. Makhoul. The young Syrian
doctor was polite and engaging. I was impressed that he had read my medical history
and was prepared to discuss the topic du jour – my breast MRI results. He
informed me that the once large tumor now measured 1.6 centimeters by .6
centimeters and the second tumor, which had always been much smaller than the
primary mass, appeared to be completely eradicated. I really wasn't sure how to
interpret what I had just heard.I
missed Don.The new doctor told me he
was going to find Dr. Makhoul and let him answer any questions I might have.

It had been nearly a month since my last visit with Dr.
Makhoul and I was actually excited to see him when he breezed into the exam
room with his new protégé. His jovial,
yet soothing tone always worked wonders on those who might be wrestling with
fear and uncertainty, like me. He wanted to know how I fared after my last
chemo treatment and I told him that I did okay; however, I was thrilled to have
the Taxol treatments behind me, because the drug was taking its toll on my
weary body. He nodded his head in agreement.

Dr. Makhoul reviewed my medical file and reiterated the
dimensions of the existing tumor. He said it was now a manageable size and my
surgeon, Dr. Suzanne Klimberg, shouldn't have any problems excising the
breast tissue.

And then he dropped a small bombshell.

“Depending on what the
pathology report shows after your surgery next week, he said, "I may recommend another
round of chemo."He
further explained that my triple negative diagnosis had everything to do with
his recommendation.Needless to say, I
was having trouble processing what I had just heard but knew it was exactly
what needed to happen.“We won’t make a
definite decision until I review the post-surgery pathology reports,” he
reminded me.Dr. Makhoul wished me good
luck with my upcoming mastectomy and said he would see me on November
5 to discuss a future treatment plan...if necessary.

As I departed the cancer institute, my mind was a whirl with
thoughts of surgery and the possibility of more chemotherapy.That aside, I was prepared to do whatever my
medical team suggested to rid my body of cancer, because I had literally placed
my life in their healing hands

One Day Before
Surgery: The Game Plan Changes

Less than a week after my appointment with Dr. Makhoul, Don
and I reported to Dr. Klimberg’s office to fill out paperwork and consult with
my surgeon the day before the scheduled procedure.Upon arrival at the women’s oncology clinic,
Don and I had to search for two chairs together in the overflowing waiting
room.As I scanned the crowd, I noticed
that only a few patients were older than me and was stunned at how many were in
their 30s and early 40s.I was curious
if the recent Angelina Jolie breast surgery phenomena had reached central Arkansas and was a
reason for seeing so many young women in the clinic. Hopefully, they were there
for preventative purposes, as Jolie demonstrated with her decision to have a
bilateral mastectomy before she actually had cancer, and not because they had
already been diagnosed with breast or gynecological cancer.

My appointment with Dr. Klimberg was scheduled for 11:00
a.m. and we expected a long wait; however, my name was called about 30 minutes
later. We were escorted to a small conference
room, where an RN specializing in tissue research counseled me on the benefits
of donating my breast tissue post-surgery to UAMS for scientific research.I wholeheartedly agreed.The fact that the type of cancer I had –
triple negative – was found in only 15% of women offered a solid reason for me
to participate in current and future research projects. My triple negative
diagnosis was starting to weigh heavily on my mind after doing a little online
research of my own.If my tissue could
help provide answers or even a vaccine, I was more than happy to help.

After I signed the release forms for the tissue donation, I
was moved to an exam room, where I waited for my consultation with Dr.
Klimberg.Her nurse, Maureen, arrived
first and handed me several forms to review about the surgery.Then Dr. Tummel, a very young associate of
Dr. Klimberg, entered the room and conducted a brief breast exam in advance of
my surgeon’s arrival. In typical
Klimberg fashion, the dry-witted doctor made an entrance into the exam room
wearing blue scrubs and accompanied by a timid, female intern.“Let’s get this show on the road,” she
directed her entourage. One of her first
duties was to explain to me all the things that could go wrong during
surgery…including death…and handed me a pen to sign the consent form, which I
did.I was given additional forms to
complete that would allow Dr. Klimberg and UAMS to use me in a lymphedema
research project she is conducting.Lymphedema is defined as arm swelling common in mastectomy patients.I was familiar with the problem after
observing a former colleague deal with a re-occurrence last year, which was a
determining factor in me signing up for the experiment(Thank you, Renee).

After all the paperwork was in order, Dr. Klimberg pulled a
permanent marker from her scrubs and began drawing possible incision lines on
each breast as Dr. Tummel and the intern observed over her shoulder.The first mark of significance was where she
planned to move my nipples, followed by the “flaps” she would create for the
plastic surgeon to insert the implants a few months later.“Are you still going to do the procedure you
created just for me?” I asked.With her
chin nestled between the thumb and forefinger of her right hand, she stared at
my breasts and responded with a comment I wasn’t expecting.

“I think your breasts are just too small for
me to do the ‘Breast Over Pants’ as planned.”

I started laughing and told madam surgeon that she is the first woman
to ever tell me that I had small breasts.“I meant it in a good way,” she said, trying to recover from her
comment.“Have you lost weight since I
first suggested the new procedure?” she inquired. In fact, I had, but I didn't
think it was a game changer.She
continued to discuss possible alternatives with Dr. Tummel for nearly 45
minutes.Finally, they had a plan.When I looked down at my apparently small
breasts, all I could see were multiple black lines that resembled a web - and
small, black dots where each nipple would be re-positioned.

Before leaving to see another patient, Dr. Klimberg told her
nurse to call the surgery scheduler and make sure I was the first patient the
following morning.In a few minutes,
Maureen returned and said Dr. Yuen, my plastic surgeon, already had the time slot
reserved for one of his patients.It was
immediately apparent that Dr. Klimberg didn't like Maureen’s answer.

“I’ll be right back,” she told me.

Within a minute, Dr. Klimberg returned with a
frustrated expression on her face and informed me that I would be second on the
surgery schedule, which would be approximately 11:00 a.m.“How long will the surgery take?” I
asked.“About four hours,” she told me
as she hugged me before leaving the exam room.

“I’ll see you before we put you to sleep,” she added.“Don’t mess with my artwork,” she told me,
pointing to my marked up breasts. After she left the room, I looked at my
watch.In less than 24 hours, I would be
in surgery, receiving a life changing procedure.It’s merely the next step in my treatment plan,
I reminded myself, as I put on my favorite bra for the last time.

Tuesday, October 8, 2013

The aches and pains from my final chemo treatment were
causing some discomfort when I reported for my appointment a few days later
with nationally known breast surgeon, Dr. Suzanne Klimberg. I nicknamed the
good doctor “Picasso” because of her penchant for drawing imaginary incision
lines on my breasts as a way to explain the upcoming mastectomy surgery.

Breast surgeon, Dr. Suzanne Klimberg.

It isn't unusual for Dr. Klimberg to
have several medical students shadowing her every move and hanging on her every
word.These fresh-faced wannabes are
eager to learn from the best in hopes of one day using their knowledge to
create new, streamlined surgical techniques or, perhaps, to develop a vaccine that
could eradicate cancer all together.There’s
no better reason to be a patient at the University of Arkansas
for Medical Sciences – the state’s only teaching hospital – because you see the
future of medicine in every young face wearing a lab coat and can’t help but
think about the possibilities.

Don, an accomplished surgeon himself, accompanied me to my
appointment to ask questions about the surgery and interpret the answers.We had only been in the exam room a few
minutes when Dr. Klimberg’s nurse came in to inquire about my chemo regimen and
to confirm the date of my last treatment.She surprised me when she requested to examine my breasts.The nurse took a black pen out of her pocket
and drew a circle very near the right nipple where she felt evidence of the remaining
cancer (Hmmmm.Apparently, everyone in
the Klimberg clinic is an artist and my breast seems to be their favorite canvas). She explained
that she was marking the area for Dr. Klimberg to evaluate.

A few minutes later Dr. K entered the room with a med
student at her side.The doctor
introduced her protégé to Don and me as one of her brightest scholars. The
fresh-faced young woman blushed at the compliment. There were now a total of
five people in the small cubicle, yet no one seemed to notice (or care) that I
was lying bare-breasted on the exam table. It was all in a day’s work for them.
I learned quickly after my first visit to the UAMS Cancer Institute six months
ago that my breasts were no longer just mine.I had to relinquish custody of “the girls” to my medical team in an
effort to rid the right one of cancer. Dr.
K moved to the right side of the exam table and the med student was on the
left.The RN was in the background
making notes.

Dr. Klimberg immediately zeroed in on the black circle made
by the nurse.She palpitated my right
breast, then the left, and moved back to the right breast where she found what
was left of the once very large mass. She instructed the med student to feel the small tumor, as well.I was beginning to
get a little nervous listening to the two of them bantering back and forth
until Dr. Klimberg explained that her concern was not the small remnant of the
tumor but rather the close proximity to the nipple. She was uneasy about
saving it. “Do you like your nipples?” she inquired.“Heck, yea,” I replied rather shocked at her
question.“Why wouldn’t I like
them?We’ve been close pals for 60
years,” I stated rather matter-of-factly. “Well, in case you didn’t or should I
not be able to save the blood supply to the right nipple, I want to assure you
that Dr. Yuen (my plastic surgeon) makes a very nice nipple.”(It’s comforting to know that my
reconstruction surgeon is known for his nipple-making.) No doubt, that was the
strangest conversation I have ever had with anyone.

I asked Dr. K if she was still planning to do the new
surgical technique created just for me in an effort to salvage more tissue and
skin for the breast reconstruction that had been delayed for six months due to
my diabetes.“Absolutely,” she remarked.
Dr. K, or should I call her Dr. Picasso, took the black pen out of her lab coat
and started drawing imaginary incision lines(Here we go again, I thought. It's “show and
tell” time).The med student listened
intently as Dr. Klimberg explained the procedure to her, as well as Don.The
two surgeons in the room – Dr. K and my significant other – began to throw
technical terms around until I reminded them that the bare-breasted patient
didn’t understand a thing they were saying.I interrupted their physician bonding moment and inquired if Dr. K had
decided on a name for the new procedure. “Breast over pants,” my surgeon said
with a straight face.Interestingly, Don
knew exactly why she chose it.He
enlightened me that there is a hernia repair called “vest over pants” and it
all had to do with making a flap that restores blood flow to the impacted area.

Dr. Klimberg shared with me that several of her students
were vying to assist her in surgery to observe this new technique. I asked how she
would determine which young surgeon-to-be would be in the operating room.“It all comes down to which one has the best
bribe,” quipped my brilliant body artist.

Dr. Klimberg’s nurse jumped in and asked if she was really
supposed to put the name “breast over pants” on the surgery orders because the
medical staff would question it, having never heard of such a procedure.“Even more reason to do it,” Dr. K responded
with a twinkle in her eye.After sitting
up on the exam table and covering my bareness with an unfashionable gown, the
nurse informed me that I was on the surgery schedule for Friday, October
11.“Do you know if it will be morning
or afternoon?” I asked.Dr. K jumped
in and said the team usually reserves the early morning surgeries for old
people and diabetics and I qualified for both.I couldn’t help but laugh out loud at her comment as did the others in
the room.The nurse handed me several
pages of instructions and told me to return for a pre-surgery consult with Dr.
Klimberg on October 10, followed by a meeting with the assigned anesthesiologist.

“It’s really going to happen,” I remarked to Don as we
exited the cancer institute.“I just
hope I’m emotionally prepared when the date rolls around.”

“I have no doubt that you will handle the surgery with the
same determination that you did the chemotherapy,” he said.From his lips to God’s ears…

About Me

Marla Crider, a 60 year-old travel professional from Little
Rock, Arkansas, is blogging her battle with invasive ductal carcinoma or in layman’s terms –
breast cancer. From the moment she discovers the lurking lump in her right
breast, she apprehensively chronicles her thoughts and emotions for public
scrutiny. Be forewarned that these postings may provide a raw glimpse into the
author’s psyche and ability to deal with a life threatening challenge. Hopefully,
Marla’s honesty, humor, and prose approach of dealing with her diagnosis and
subsequent treatment plan will help others who find themselves in a crusade of
their own. You may follow her journey here: www.MarlaCrider.com . Marla has lived and worked previously in Fayetteville, Arkansas and Hot Springs, Arkansas.

Invasive Ductal Carcinoma: What is it?

Invasive ductal carcinoma (IDC) is the most common form of invasive breast cancer. It accounts for 80% of breast cancer incidence upon diagnosis, according to statistics from the U.S. in 2004. On a mammogram, it is usually visualized as a mass with fine spikes radiating from the edges. On physical examination, the lump usually feels much harder or firmer than benign breast lesions such as fibroadenoma. On microscopic examination, the cancerous cells invade and replace the surrounding normal tissues.

Mammograms

Breast tissue is composed of fatty (nondense) tissue and connective (dense) tissue. Radiologists use a grading system to describe the density of breast tissue based on the proportion of fat to connective tissue. There are four levels of density that are detected by mammograms: Level 1 (a very fatty breast), level 2 (fatty tissue makes up more than 50 percent of breast), level 3 (dense tissue makes up more than 50 percent of the breast) and level 4 (a very dense breast with very little fat). Click the image above for more information from the Mayo Clinic.

Get a Breast Cancer Screening

Click map to find a screening site near you.

All original content copyright (c) 2013, Marla F. Crider and marlacrider.com. You are free to share (copy, distribute and transmit) content from this site with attribution to marlacrider.com.